10 Shocking Facts About Canada’s Healthcare System – Part 3

August 28, 2018

Part 3. Canada Has No Interest In Fraud, Only In Spending

In the article “What you need to know about the Canada Health Transfer” of December 2016 the Globe and Mail reported “The Canada Health Transfer is the money the federal government sends to the provinces and territories to help pay for health care, which is a provincial responsibility. Ottawa can use the CHT to enforce the Canada Health Act, although, in practice, it rarely does.

The transfer can be clawed back if a province fails to uphold any of the act’s five principles:

universality,

comprehensiveness,

portability,

accessibility and

public administration.

So not only is protecting taxpayers from fraud clearly not one of these five principles, there is no law enforcement unit anywhere in the federal government that exists to deal with it. Therefore, it is clear that the feds’ health budget is practically free money.

Prime Minister Trudeau’s “health mandate” nowhere even remotely addresses the issue and the Royal Canadian Mounted Police, which is a federal agency that acts as provincial police for numerous provinces, has no health fraud mandate. Take Saskatchewan as an example, where doctors can use any of 3500 different billings codes and which “to some extent uses the honour system,” to quote a June 2017 article by CBC News.

The case of Ontario

The Ontario Ministry of Health and Long-Term Care claims in their website to be “committed to detecting abuse and misuse of the Ontario health care system”. And who, according to them, is committing the health care fraud? Persons who:

knowingly use a health card that is not theirs

receive OHIP services who are aware that as a non-resident of Ontario they are not eligible

knowingly gives false information to the ministry to become or continue to be an insured person when they are aware that they are not eligible.

The Ministry claims that they investigate “each and every allegation it receives regarding potential health insurance fraud”. Who do they think they’re kidding? Do they really think that tracking down someone from out of province who is using their cousin Fred’s OHIP card is going to put any kind of dent in the enormous health care fraud bill that taxpayers bear? The ministry makes NO mention of investigating fraud perpetrated by practitioners. There isn’t even a hint of it.

Hindering law enforcement

Ontario, unlike many of the other provinces, at least has established a police unit charged with the detection, investigation and pursuit of health care fraud. The Anti-Rackets Branch of the OPP (Ontario Provincial Police) has a Health Fraud Investigation Unit, comprised of 19 officers. But as noted in part 2 of our series, the Ministry has been very lax in forwarding suspected fraud cases to the OPP’s Health Fraud Investigation Unit.

In fact, after waiting in vain for years for the Ministry to send them some cases to investigate, this police unit had to contact the Ministry and ask that they send some. And what did the Ministry send them? The Unit received 13 cases, eight of which were considered as being too old to investigate. The Ministry stepped up their game in 2016-2017, reporting six cases of possible billing fraud to the OPP, but did not follow up to see whether charges had been laid or the practitioner convicted. The police, who will vigorously investigate suspected fraud, are being sabotaged by the Ministry.

And even when the officers uncover medical fraud and charge the perpetrators, the sentences are often so light as to be meaningless.

And did you know that pharmacists and doctors convicted of OHIP fraud are very rarely stripped of their licenses to practice by the Colleges that supposedly regulate these professions? Furthermore, did you know that doctors charged by the police with committing fraud are defended in court by high-priced lawyers that you pay for? Don’t believe it?

Comments

Like most of the material here, this also is not true. The Canadian Healthcare Anti-fraud Association is an industry and government group actually working on fraud detection, prevention and law enforcement.